What is the medical term and treatment for Diabetes (Diabetes Mellitus) involving vomiting, specifically diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

From the Guidelines

Diabetic ketoacidosis (DKA) is the medical term for a serious complication of diabetes that involves vomiting, and the most effective treatment approach is individualized based on a careful clinical and laboratory assessment, with management goals including restoration of circulatory volume and tissue perfusion, resolution of ketoacidosis, and correction of electrolyte imbalance and acidosis, as recommended by the most recent guidelines 1.

Key Components of Treatment

• Intravenous (IV) fluids to rehydrate the body, with an initial fluid replacement of normal saline at 15-20 mL/kg in the first hour
• Insulin therapy to lower blood glucose levels, with a continuous intravenous infusion of regular insulin at a dose of 0.1 unit kg–1 h–1, as supported by earlier studies 1
• Electrolyte replacement, particularly potassium, sodium, and chloride, to correct electrolyte imbalance and acidosis
• Frequent monitoring of blood glucose, electrolytes, and pH levels, with insulin dosage adjusted accordingly

Recent Recommendations

The most recent guidelines suggest that in critically ill and mentally obtunded individuals with DKA or HHS, continuous intravenous insulin is the standard of care, and successful transition from intravenous to subcutaneous insulin requires administration of basal insulin 2–4 h before the intravenous insulin is stopped to prevent recurrence of ketoacidosis and rebound hyperglycemia 1.

Important Considerations

• The use of bicarbonate in people with DKA is generally not recommended, as it has been shown to make no difference in the resolution of acidosis or time to discharge 1
• The underlying cause of DKA must be identified and treated, which may include addressing infection, medication non-compliance, or other triggers
• Prevention involves regular blood glucose monitoring, consistent medication adherence, and seeking medical attention promptly when ill.

From the FDA Drug Label

Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin Hyperglycemia can be brought about by any of the following: Omitting your insulin or taking less than your doctor has prescribed. Eating significantly more than your meal plan suggests. Developing a fever, infection, or other significant stressful situation. In patients with type 1 or insulin-dependent diabetes, prolonged hyperglycemia can result in DKA (a life-threatening emergency) The first symptoms of DKA usually come on gradually, over a period of hours or days, and include a drowsy feeling, flushed face, thirst, loss of appetite, and fruity odor on the breath. With DKA, blood and urine tests show large amounts of glucose and ketones. Heavy breathing and a rapid pulse are more severe symptoms If uncorrected, prolonged hyperglycemia or DKA can lead to nausea, vomiting, stomach pain, dehydration, loss of consciousness, or death.

Early signs of diabetic ketoacidosis include glycosuria and ketonuria Polydipsia, polyuria, loss of appetite, fatigue, dry skin, abdominal pain, nausea and vomiting and compensatory tachypnea come on gradually, usually over a period of some hours or days, in conjunction with hyperglycemia and ketonemia.

The medical term for diabetes involving vomiting is Diabetic Ketoacidosis (DKA).

• Treatment for DKA typically involves:
  • Intravenous administration of glucose and insulin
  • Fluid replacement to correct dehydration
  • Electrolyte replacement to correct imbalances
  • Monitoring of blood glucose and ketone levels
  • Treatment of any underlying infections or other conditions that may have contributed to the development of DKA 2 2.

From the Research

Diabetes Involving Vomiting Medical Term

• The medical term for diabetes involving vomiting is diabetic gastroparesis, which is a state of delayed gastric emptying that reportedly affects 20-30% of diabetic patients 3.
• Diabetic gastroparesis is defined as delayed gastric emptying without mechanical obstruction in the setting of diabetes, and symptoms range from mild bloating to severe vomiting episodes 4.

Treatment Options

• Current management for diabetic gastroparesis focuses on dietary and lifestyle changes as well as improved glycemic control, with limited options for medical therapies available, including prokinetic and antiemetic medications 4.
• Metoclopramide is the only FDA-approved medication for the treatment of gastroparesis, and it improves symptoms of gastroparesis, although extended treatment presents challenges such as decreased efficacy over time and increased risks for adverse events 4, 5.
• Other treatment options include domperidone, cisapride, and gastric electrical stimulation, which have shown promise in the treatment of diabetic gastroparesis 3, 6, 7.
• Mechanical therapies such as endoscopic pyloric botulinum toxin injection, gastric electrical stimulation, and gastrostomy or jejunostomy are used in intractable diabetic gastroparesis, refractory to prokinetic therapies 6.

Symptoms and Pathogenesis

• Symptoms of diabetic gastroparesis include nausea, vomiting, abdominal fullness, and early satiety, which impact to varying degrees on the patient's quality of life 3, 4, 6.
• The pathogenesis of diabetic gastroparesis remains unclear, but proposed mechanisms include vagal dysfunction, hyperglycemia, interstitial cells of Cajal network disturbances, loss of neural nitric oxide synthase expression in the myenteric plexus, and oxidative stress 4.